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2015 ; 41
(ä): 89
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Probiotics for prevention of necrotizing enterocolitis in preterm infants:
systematic review and meta-analysis
#MMPMID26567539
Aceti A
; Gori D
; Barone G
; Callegari ML
; Di Mauro A
; Fantini MP
; Indrio F
; Maggio L
; Meneghin F
; Morelli L
; Zuccotti G
; Corvaglia L
Ital J Pediatr
2015[Nov]; 41
(ä): 89
PMID26567539
show ga
Necrotizing enterocolitis (NEC) affects predominantly preterm infants, who have
specific risk factors leading to intestinal dysbiosis. Manipulations of gut
microbiota through probiotics have the potential to prevent NEC.The aim of this
systematic review and meta-analysis was to evaluate the effect of probiotics for
NEC prevention in preterm infants, with a focus on specific strains,
microbiological strength of currently available studies, and high-risk
populations. PubMed and the Cochrane Library were searched for trials published
within 4th February 2015. Randomized-controlled trials reporting on NEC and
involving preterm infants who were given probiotics in the first month of life
were included in the systematic review.Twenty-six studies were suitable for
inclusion in the meta-analysis.Data about study design, population, intervention
and outcome were extracted and summarized independently by two observers. Study
quality and quality of evidence were also evaluated.Fixed-effects models were
used and random-effects models where significant heterogeneity was present.
Subgroup analyses were performed to explore sources of heterogeneity among
studies. Results were expresses as risk ratio (RR) with 95 % confidence interval
(CI). The main outcome was incidence of NEC stage ?2 according to Bell's
criteria. Probiotics prevented NEC in preterm infants (RR 0.47 [95 % CI
0.36-0.60], p?0.00001). Strain-specific sub-meta-analyses showed a significant
effect for Bifidobacteria (RR 0.24 [95 % CI 0.10-0.54], p?=?0.0006) and for
probiotic mixtures (RR 0.39 [95 % CI 0.27-0.56], p?0.00001). Probiotics
prevented NEC in very-low-birth-weight infants (RR 0.48 [95 % CI 0.37-0.62],
p?0.00001); there were insufficient data for extremely-low-birth-weight
infants. The majority of studies presented severe or moderate microbiological
flaws.Probiotics had an overall preventive effect on NEC in preterm infants.
However, there are still insufficient data on the specific probiotic strain to be
used and on the effect of probiotics in high-risk populations such as
extremely-low-birth-weight infants, before a widespread use of these products can
be recommended.
|*Infant, Premature
[MESH]
|Enterocolitis, Necrotizing/*prevention & control
[MESH]
|Humans
[MESH]
|Infant, Newborn
[MESH]
|Infant, Premature, Diseases/*prevention & control
[MESH]